Risk Management

The Profession

TriMet's Debora Leopold Hutchins blends risk management into her personal life.
By: | November 3, 2014

R&I:  What was your first job?

My first job during college was working for St. Paul Insurance Co. as a rater, coder trainee in the personal lines department in Portland, Ore.

R&I:  How did you come to work in risk management?

11012014_18_profession_prof_230px300pxI had always wanted to become a risk manager when I was an insurance broker. An opportunity arose … at TriMet to manage its owner-controlled insurance program [OCIP]. Three years later, I took over the responsibility of managing the agency’s property/casualty and workers compensation insurance portfolio. Previously, I’d also worked for Fred S. James and Sedgwick.

R&I: What sorts of challenges have colleagues been able to help you tackle?

I came to my employer with no construction background to manage an OCIP. While I’m still learning the construction acronyms and the various means and methods of construction, I’m feeling more comfortable around major heavy construction projects with billions of dollars of new infrastructure.

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R&I:  What emerging commercial risk most concerns you?

For me in my role, cyber risk, mainly because we offer so many electronic transit tools for our riders to use. I’m concerned about the “what if” if someone hacks into any of those e-tools and gains access to the riders’ personal identifying information (PII). For instance, right now we are working on a complete electronic e-fare system allowing the rider to use their smart phone, credit card or debit card to purchase daily, weekly or monthly passes.

R&I: What could the risk management community be doing a better job of?

Even though I see an increase in young risk management professionals, industrywide we could be working to introduce more young professionals into the field of insurance and risk management.

R&I:  What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

I’ve seen a more diverse group of risk managers, including a younger group, which is good for the industry as baby boomers start to look towards retirement. More and more organizations are finally looking at the risk management function as an essential role in their organization.

R&I: What insurance carrier do you have the highest opinion of?

R6-14p42_Profession.inddI don’t have as much of an opinion about the companies as I do about the brokers I work with. I can work with any insurance company provided they can insure my organization with broad terms and conditions. However, the relationship I have with my insurance brokers is most important to me and I have a good relationship with both my insurance brokers — Marsh and Alliant Insurance Services.

R&I: Is the contingent commission controversy overblown?

I’ll put it this way: I prefer that my broker not receive a contingent commission. Whether they’re paid through a fee arrangement or on commission, I want them to be totally up-front and transparent about the compensation they receive on my account. As a public agency, I need full transparency and disclosure of the fee my broker receives.

R&I: Are you optimistic about the U.S. economy or pessimistic and why?

I’m by nature a pessimistic person, and I think we have a ways to go with the economy. Since 2008, Oregon in particular is still trying to make a comeback. Jobs are starting to open up, the value of homes is starting to rise, and salaries are slowly rising. Six years later, we’re still trying to play catch up with the rest of the United States.

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R&I: What is the riskiest activity you ever engaged in?

I have a fear of water, not being able to see what’s in the water and not being able to touch the bottom. And yet I had the courage to participate for eight years on a dragon boat competition team. Being on that team took me to Italy to compete in the World Crew Club World Championship.

R&I: What have you accomplished that you are proudest of?

I took first place in the National Association of Insurance Women (NAIW) National Oratory Competition in late 1980s. And besides competing in the World Crew Club Championship, I participated in a 675-mile bike ride over six days sponsored by Cycle Oregon in 2000.

I am a student of insurance. It’s fulfilling to me because I am at the forefront of making sure the agency’s risks are managed effectively whether through risk retention, risk transfer, risk avoidance or a combination of all those methods.

R&I: Who is your mentor and why?

I have many mentors; most of them came out of the NAIW. There are three that I’ll mention: Careen Adams, Libby Rawls and Doreen Young.

In the 1980s, Libby and Careen hired me from St. Paul Insurance and I worked for them at Cole Clark & Cunningham, a small independent insurance agency now known as Aon Risk Services.

Both Libby and Careen were insurance producers, something that was unheard of for women at the time. Libby encouraged me to get my ARM and CPCU and Careen made it so that I was promoted to a senior account underwriter before she left the company. …

Doreen was a customer service representative for a competitor and she is responsible for helping me gain the confidence and courage to stay in the industry and work my way through some of the same challenges she, Libby and Careen faced.

R&I: What is your favorite book or movie?

I’m not a pleasure reader, but two months ago a colleague insisted that I read “The Glass House” and I loved it.

R&I: What is the most unusual/interesting place you have ever visited?

Italy. I loved visiting the Coliseum, what it represented brought a lot of emotions for me as a Christian. I could feel the pain the Christians endured being used as a gaming tool during that era. It was amazing.

R&I: What about this work do you find the most fulfilling or rewarding?

I absolutely love insurance; I am a student of insurance. It’s fulfilling to me because I am at the forefront of making sure the agency’s risks are managed effectively whether through risk retention, risk transfer, risk avoidance or a combination of all those methods. I enjoy helping people, and when you’re in this field people come to you with a lot of questions, like, “What if we took on this, this and this, what would be the outcome?”

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R&I: What do your friends and family think you do?

They know that I manage risk because I take what I do and I blend it into my personal life.

It drives my daughter crazy when I say, “Check your car before you get inside or make sure you have your house key in your hand when you’re getting home late at night. She’ll say, “There you go, Mom, always managing risk.” My husband will kind of lower his eyebrows and say, “OK, here comes my risk management session for the day.”

Risk is around us every day and when you work in it every day it becomes part of who you are.

Janet Aschkenasy is a freelance financial writer based in New York. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Scenario

The Betrayal of Elizabeth

In this Risk Scenario, Risk & Insurance explores what might happen in the event a telemedicine or similar home health visit violates a patient's privacy. What consequences await when a young girl's tele visit goes viral?
By: | October 12, 2020
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

PART ONE: CRACKS IN THE FOUNDATION

Elizabeth Cunningham seemingly had it all. The daughter of two well-established professionals — her father was a personal injury attorney, her mother, also an attorney, had her own estate planning practice — she grew up in a house in Maryland horse country with lots of love and the financial security that can iron out at least some of life’s problems.

Tall, good-looking and talented, Elizabeth was moving through her junior year at the University of Pennsylvania in seemingly good order; check that, very good order, by all appearances.

Her pre-med grades were outstanding. Despite the heavy load of her course work, she’d even managed to place in the Penn Relays in the mile, in the spring of her sophomore season, in May of 2019.

But the winter of 2019/2020 brought challenges, challenges that festered below the surface, known only to her and a couple of close friends.

First came betrayal at the hands of her boyfriend, Tom, right around Thanksgiving. She saw a message pop up on his phone from Rebecca, a young woman she thought was their friend. As it turned out, Rebecca and Tom had been intimate together, and both seemed game to do it again.

Reeling, her holiday mood shattered and her relationship with Tom fractured, Elizabeth was beset by deep feelings of anxiety. As the winter gray became more dense and forbidding, the anxiety grew.

Fed up, she broke up with Tom just after Christmas. What looked like a promising start to 2020 now didn’t feel as joyous.

Right around the end of the year, she plucked a copy of her father’s New York Times from the table in his study. A budding physician, her eyes were drawn to a piece about an outbreak of a highly contagious virus in Wuhan, China.

“Sounds dreadful,” she said to herself.

Within three months, anxiety gnawed at Elizabeth daily as she sat cloistered in her family’s house in Bel Air, Maryland.

It didn’t help matters that her brother, Billy, a high school senior and a constant thorn in her side, was cloistered with her.

She felt like she was suffocating.

One night in early May, feeling shutdown and unable to bring herself to tell her parents about her true condition, Elizabeth reached out to her family physician for help.

Dr. Johnson had been Elizabeth’s doctor for a number of years and, being from a small town, Elizabeth had grown up and gone to school with Dr. Johnson’s son Evan. In fact, back in high school, Evan had asked Elizabeth out once. Not interested, Elizabeth had declined Evan’s advances and did not give this a second thought.

Dr. Johnson’s practice had recently been acquired by a Virginia-based hospital system, Medwell, so when Elizabeth called the office, she was first patched through to Medwell’s receptionist/scheduling service. Within 30 minutes, an online Telehealth consult had been arranged for her to speak directly with Dr. Johnson.

Due to the pandemic, Dr. Johnson called from the office in her home. The doctor was kind. She was practiced.

“So can you tell me what’s going on?” she said.

Elizabeth took a deep breath. She tried to fight what was happening. But she could not. Tears started streaming down her face.

“It’s just… It’s just…” she managed to stammer.

The doctor waited patiently. “It’s okay,” she said. “Just take your time.”

Elizabeth took a deep breath. “It’s like I can’t manage my own mind anymore. It’s nonstop. It won’t turn off…”

More tears streamed down her face.

Patiently, with compassion, the doctor walked Elizabeth through what she might be experiencing. The doctor recommended a follow-up with Medwell’s psychology department.

“Okay,” Elizabeth said, some semblance of relief passing through her.

Unbeknownst to Dr. Johnson, her office door had not been completely closed. During the telehealth call, Evan stopped by his mother’s office to ask her a question. Before knocking he overheard Elizabeth talking and decided to listen in.

PART TWO: BETRAYAL

As Elizabeth was finding the courage to open up to Dr. Johnson about her psychological condition, Evan was recording her with his smartphone through a crack in the doorway.

Spurred by who knows what — his attraction to her, his irritation at being rejected, the idleness of the COVID quarantine — it really didn’t matter. Evan posted his recording of Elizabeth to his Instagram feed.

#CantManageMyMind, #CrazyGirl, #HelpMeDoctorImBeautiful is just some of what followed.

Elizabeth and Evan were both well-liked and very well connected on social media. The posts, shares and reactions that followed Evan’s digital betrayal numbered in the hundreds. Each one of them a knife into the already troubled soul of Elizabeth Cunningham.

By noon of the following day, her well-connected father unleashed the dogs of war.

Rand Davis, the risk manager for the Medwell Health System, a 15-hospital health care company based in Alexandria, Virginia was just finishing lunch when he got a call from the company’s general counsel, Emily Vittorio.

“Yes?” Rand said. He and Emily were accustomed to being quick and blunt with each other. They didn’t have time for much else.

“I just picked up a notice of intent to sue from a personal injury attorney in Bel Air, Maryland. It seems his daughter was in a teleconference with one of our docs. She was experiencing anxiety, the daughter that is. The doctor’s son recorded the call and posted it to social media.”

“Great. Thanks, kid,” Rand said.

“His attorneys want to initiate a discovery dialogue on Monday,” Emily said.

It was Thursday. Rand’s dreams of slipping onto his fishing boat over the weekend evaporated, just like that. He closed his eyes and tilted his face up to the heavens.

Wasn’t it enough that he and the other members of the C-suite fought tooth and nail to keep thousands of people safe and treat them during the COVID-crisis?

He’d watched the explosion in the use of telemedicine with a mixture of awe and alarm. On the one hand, they were saving lives. On the other hand, they were opening themselves to exposures under the Health Insurance Portability and Accountability Act. He just knew it.

He and his colleagues tried to do the right thing. But what they were doing, overwhelmed as they were, was simply not enough.

PART THREE: FALLING DOMINOES

Within the space of two weeks, the torture suffered by Elizabeth Cunningham grew into a class action against Medwell.

In addition to the violation of her privacy, the investigation by Mr. Cunningham’s attorneys revealed the following:

Medwell’s telemedicine component, as needed and well-intended as it was, lacked a viable informed consent protocol.

The consultation with Elizabeth, and as it turned out, hundreds of additional patients in Maryland, Pennsylvania and West Virginia, violated telemedicine regulations in all three states.

Numerous practitioners in the system took part in teleconferences with patients in states in which they were not credentialed to provide that service.

Even if Evan hadn’t cracked open Dr. Johnson’s door and surreptitiously recorded her conversation with Elizabeth, the Medwell telehealth system was found to be insecure — yet another violation of HIPAA.

The amount sought in the class action was $100 million. In an era of social inflation, with jury awards that were once unthinkable becoming commonplace, Medwell was standing squarely in the crosshairs of a liability jury decision that was going to devour entire towers of its insurance program.

Adding another layer of certain pain to the equation was that the case would be heard in Baltimore, a jurisdiction where plaintiffs’ attorneys tended to dance out of courtrooms with millions in their pockets.

That fall, Rand sat with his broker on a call with a specialty insurer, talking about renewals of the group’s general liability, cyber and professional liability programs.

“Yeah, we were kind of hoping to keep the increases on all three at less than 25%,” the broker said breezily.

There was a long silence from the underwriters at the other end of the phone.

“To be honest, we’re borderline about being able to offer you any cover at all,” one of the lead underwriters said.

Rand just sat silently and waited for another shoe to drop.

“Well, what can you do?” the broker said, with hope draining from his voice.

The conversation that followed would propel Rand and his broker on the difficult, next to impossible path of trying to find coverage, with general liability underwriters in full retreat, professional liability underwriters looking for double digit increases and cyber underwriters asking very pointed questions about the health system’s risk management.

Elizabeth, a strong young woman with a good support network, would eventually recover from the damage done to her.

Medwell’s relationships with the insurance markets looked like it almost never would. &

Bar-Lessons-Learned---Partner's-Content-V1b

Risk & Insurance® partnered with Allied World to produce this scenario. Below are Allied World’s recommendations on how to prevent the losses presented in the scenario. This perspective is not an editorial opinion of Risk & Insurance.®.

The use of telehealth has exponentially accelerated with the advent of COVID-19. Few health care providers were prepared for this shift. Health care organizations should confirm that Telehealth coverage is included in their Medical Professional, General Liability and Cyber policies, and to what extent. Concerns around Telehealth focus on HIPAA compliance and the internal policies in place to meet the federal and state standards and best practices for privacy and quality care. As states open businesses and the crisis abates, will pre-COVID-19 telehealth policies and regulations once again be enforced?

Risk Management Considerations:

The same ethical and standard of care issues around caring for patients face-to-face in an office apply in telehealth settings:

  • maintain a strong patient-physician relationship;
  • protect patient privacy; and
  • seek the best possible outcome.

Telehealth can create challenges around “informed consent.” It is critical to inform patients of the potential benefits and risks of telehealth (including privacy and security), ensure the use of HIPAA compliant platforms and make sure there is a good level of understanding of the scope of telehealth. Providers must be aware of the regulatory and licensure requirements in the state where the patient is located, as well as those of the state in which they are licensed.

A professional and private environment should be maintained for patient privacy and confidentiality. Best practices must be in place and followed. Medical professionals who engage in telehealth should be fully trained in operating the technology. Patients must also be instructed in its use and provided instructions on what to do if there are technical difficulties.

This case study is for illustrative purposes only and is not intended to be a summary of, and does not in any way vary, the actual coverage available to a policyholder under any insurance policy. Actual coverage for specific claims will be determined by the actual policy language and will be based on the specific facts and circumstances of the claim. Consult your insurance advisors or legal counsel for guidance on your organization’s policies and coverage matters and other issues specific to your organization.

This information is provided as a general overview for agents and brokers. Coverage will be underwritten by an insurance subsidiary of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Such subsidiaries currently carry an A.M. Best rating of “A” (Excellent), a Moody’s rating of “A3” (Good) and a Standard & Poor’s rating of “A-” (Strong), as applicable. Coverage is offered only through licensed agents and brokers. Actual coverage may vary and is subject to policy language as issued. Coverage may not be available in all jurisdictions. Risk management services are provided or arranged through AWAC Services Company, a member company of Allied World. © 2020 Allied World Assurance Company Holdings, Ltd. All rights reserved.




Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]